Healthcare Provider Details

I. General information

NPI: 1053159160
Provider Name (Legal Business Name): CAMILLE PATTON PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 E 54TH ST APT 2
NEWBURGH HEIGHTS OH
44105-4851
US

IV. Provider business mailing address

3998 E 54TH ST APT 2
NEWBURGH HEIGHTS OH
44105-4851
US

V. Phone/Fax

Practice location:
  • Phone: 216-647-8579
  • Fax:
Mailing address:
  • Phone: 216-647-8579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: